Basic Information
| Provider Information | |||||||||
| NPI: | 1548453863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISCHEL | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 W GRAND BLVD | ||||||||
| Address2: | STE 2000 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009724283 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 CHRYSLER DR TOLAN PARK | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482013096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139933964 | ||||||||
| FaxNumber: | 3139933974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801015691 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6801015691 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.